Abstract | BACKGROUND: METHODS: Clinical response, disease activity indices, adverse events, and clinical outcomes were measured up to 1 year after antibiotic treatment in this retrospective cohort study of children with medically refractory IBD colitis. RESULTS: Sixty-three patients with refractory UC, Crohn's colitis, and IBD-U (median age [interquartile range {IQR}], 15.3 [11.2-16.5] years; median disease duration [IQR], 1.2 [0.41-4.6] years) received a combination of 3 or 4 oral antibiotics (most commonly amoxicillin, metronidazole, and either doxycycline or ciprofloxacin) for a median (IQR) of 29 (21-58) days. Thirty-four patients (54%) were deemed corticosteroid-refractory or -dependent, with the majority (62/63) having a previous or present loss of response or primary nonresponse to anti- tumor necrosis factor alpha (anti-TNFα) therapy. Use of combination antibiotics led to a significant decrease in median Pediatric Ulcerative Colitis Activity Index (PUCAI) score (IQR) from 55 (40-65) to 10 (0-40; P < 0.0001) over 3 ± 1 weeks, with 25/63 (39.7%) patients achieving clinical remission (PUCAI <10 points). The clinical benefits of oral antibiotics were independent of anti-TNFα therapy optimization. Among children entering clinical remission (n = 25), only 1 patient required surgery at 1-year follow-up, vs 10 patients in the nonresponder group. Negative predictors of response to combination antibiotics were exposure to doxycycline (odds ratio [OR], 0.25; 95% CI, 0.08-0.76) and PUCAI ≥65 at baseline (OR, 0.2; 95% CI, 0.05-0.74). CONCLUSIONS:
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Authors | Jessica Breton, Arthur Kastl, Natalie Hoffmann, Rachel Rogers, Andrew B Grossman, Petar Mamula, Judith R Kelsen, Robert N Baldassano, Lindsey Albenberg |
Journal | Inflammatory bowel diseases
(Inflamm Bowel Dis)
Vol. 25
Issue 9
Pg. 1586-1593
(08 20 2019)
ISSN: 1536-4844 [Electronic] England |
PMID | 30715364
(Publication Type: Journal Article, Research Support, N.I.H., Extramural)
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Copyright | © 2019 Crohn’s & Colitis Foundation. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: [email protected]. |
Chemical References |
- Anti-Bacterial Agents
- Immunosuppressive Agents
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Topics |
- Adolescent
- Anti-Bacterial Agents
(therapeutic use)
- Bacterial Infections
(chemically induced, drug therapy, pathology)
- Child
- Child, Preschool
- Drug Resistance
(drug effects)
- Drug Therapy, Combination
- Female
- Follow-Up Studies
- Humans
- Immunosuppressive Agents
(adverse effects)
- Inflammatory Bowel Diseases
(drug therapy, pathology)
- Male
- Prognosis
- Remission Induction
- Retrospective Studies
- Severity of Illness Index
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